It is well understood that microbiological pathogens on the hands are transferred to other body parts such as the mouth, nose and eyes and this transfer is the primary route for infectious disease in humans. The actual extent of the damage caused by infections resulting from hand-borne pathogens is generally less known. Fully eighty percent of all infections ranging from the usually benign cold, through the more debilitating flu, to the truly horrific Ebola, are transmitted by touch. The average American will contract two to four cold or flu infections in a typical year, and experience four to six significant gastrointestinal disruptions during the same period. Colds alone account for an annual loss in the United States of at least 300 million person days of work and school annually; flus cost Americans $10 billion a year in lost wages and medical expenditures in addition to nearly 50,000 deaths each year from influenza complications. Additionally, over and above the easily recognized onset of miseries characterized by the likes of a Norwalk virus attack, there is a growing body of evidence and in some cases solid proof that many major chronic diseases like gastric ulcers, stomach cancer, heart disease, cervical cancer, ALS (Lou Gehrig's disease), and Alzheimer's, most characterized by a much delayed onset, are infectious germ-based diseases that follow the same hand-based route into the body as the common cold rhinovirus. The scope of this generally unrecognized hidden plague associated with infectious diseases has been discussed for years within the medical community and more recently has found its way into the popular press, Atlantic Monthly, February 1999, (“A New Germ Theory”). It is sobering to realize the risk of a hand-borne infection is not just the occasional case of the sniffles but possibly the source of a life-long debilitating disease, a crippling condition leading to an early death, or even a tragic living death that strangles all hope and affection. For years the famed Mayo Clinic has offered this blunt slogan in an attempt to drive home the need for effective hand hygiene to combat serious diseases: “The ten worst sources of contagion are our fingers.”
Each year more than 2 million hospital acquired (nosocomial) infections occur in the United States, costing some $4.5 billion in additional charges. The Centers for Disease Control estimates more than half of healthcare associated infections can be prevented through better infection control programs of which hand cleaning is the centerpiece for reducing the spread of infection. Hospitals are only one of many organizations burdened with hand-borne disease costs. A recent school study found that classrooms that made hand sanitizing fluid dispensers simply available for use showed a 20% reduction in student absenteeism due to illness as well as a 10% decrease in teacher absenteeism. Several recent articles provide an understanding of the current level of technology available for hand sanitation and further describe the significant problems the art of infection control faces.
In March 2001 an American Journal of Nursing article (“Improved Rates of Compliance with Hand Antisepsis . . . ”) stated that at least 80,000 hospital deaths occur each year as a result of nosocomial infections contracted during their stays. Further, that “it's common knowledge that the hands of heath care workers can carry disease-causing organisms from one patient to another and that hand antisepsis before and after each patent contact is crucial to the prevention and control of nosocomial infection.” The reasons most often cited by hospital staff for failing to clean their hands adequately are inconvenience and no time. Given the hectic and demanding nature of their workload these are not excuses but simply statements of reality. That convenience and time are critical factors in maintaining hand sanitation is underscored by the finding in this study that placing hand sanitizing fluid dispensers “in the hallways outside patient rooms were nearly 30 times more likely to be used than dispensers mounted anywhere inside the rooms.” Yet the most disturbing finding of this study was that full compliance with hand antisepsis guidelines was an unrealistic goal. That while hand sanitizing fluids took less time than washing and the placement of numerous dispensers bottles made matters somewhat more convenient, even with the heightened attention impact of the study itself (the Hawthorne effect), compliance did not achieve more than 60% at any time during the study. And it is well understood that over time, after the study is done and gone, a drift back to much lower compliance rates is inevitable; the dispenser bottle becomes just one more thing in the room, like soap at the sink, rarely used and only when time and convenience allowed.
In March 2002 an article in Infection Control and Hospital Epidemiology (“Promotion of Hand Hygiene: Magic, Hype, or Scientific Challenge?”) restates the conditions for promoting adequate hand hygiene. “Among enabling factors, engineering control must be considered for the successful promotion of hand hygiene. In particular, it involves making hand hygiene easy, convenient, and possible in a timely fashion.” Another observation made is that the higher rates of compliance seen in studies can only be sustained when some form of cost-effective, non-intrusive monitoring is invented. “My personal opinion is that obtaining a sustained and never-ending Hawthorne effect associated with improved compliance with hand hygiene and decreased infection and cross-transmission rates should be the dream of every hospital epidemiologist. Let's find a cost-effective way to induce it.” To date this need and its underlying causes remain unmet both in the marketplace and the published art.
A final article in the October 2000 issue of Family Medicine (“Alcohol-free Instant Hand Sanitizer Reduces Elementary School Illness Absenteeism”) reports a remarkable reduction in absenteeism when hand sanitizers were introduced in public school classrooms. Results showed students using hand sanitizing fluids “were found to have 41.9% fewer illness-related absence days, representing a 28.9% and a 49.7% drop in gastrointestinal- and respiratory-related illness, respectively . . . Conclusion: Daily use of the instant hand sanitizer was associated with significantly lower rates of illness-related absenteeism.” In this study the close monitoring and continual instruction of the test group by teachers largely abrogated the issues of time and convenience. Nevertheless, it clearly indicates the significant impact consistent and rigorous hand sanitation can have in schools and the implications for parallel benefits at all levels of society are obvious. As the reports point out in describing the interlinking cost of disease “Even if one doesn't have school-age children, it is necessary to understand the importance and benefits of good hand hygiene, not only in clinical practice but also in the greater community. Vital tax dollars will be saved on expenses for remedial student services and employee work time by this simple and effective way to decrease illness-related absenteeism.”
That the use of hand sanitizing fluids can significantly reduce infections and disease is beyond question, but the problem remains of how to establish widespread use. Despite their presents in hospitals and the marketplace for years the evidence shows a lack of effective impact. Part of the problem lies in development of a useful, convenient and affordable apparatus, a devices that flows naturally with the rhythms of the workplace or daily life. In hospitals and schools placing dispensers at doors produced statistically significant improvements in hand hygiene; it has also been shown that recidivism is immediate when compliance monitoring stops. Dispensers hung on walls or set on counters have proven only marginally effective in the controlled environment of hospitals and schools; in public areas their effectiveness rating drops to near zero. The state of the art as defined by the marketplace and patent literature provides neither devices nor methods that adequately address this problem.
To improve hand hygiene in the general population two basic and novel developments need to take place. The first is development of an apparatus, a device that is inexpensive, disposable, multi-dose, small, convenient, self-sealing, ubiquitous, inconspicuous, a pocket carried packet dispenser of hand sanitizing fluid that is accessible in a timely manner in the course of a day's normal activities. An apparatus with these specifications is described in a pending U.S. patent application Ser. No. 10/602,448 to Harper wherein the Athand™ packet is disclosed. The second development necessary for improved hand hygiene is creation of a robust and effective means to promote the distribution and retention of the Athand packet so it is available at a time and place of appropriate need.
The Harper application describes the use of various forms of advertising and gaming in an attempt to achieve widespread distribution and retention of the packets. Harper explicitly describes the printing of various forms of promotional data including advertising messages, internet addresses, company names and the like on the exterior surface of the packets. Using this marketing format the hand sanitizing fluid packet comes close to becoming the twenty-first century equivalent of the last century's ubiquitous matchbook. But there are problems with the conventional exterior printing of packets as described by Harper. First, the packet space available is very small and must compete with necessary regulatory information. Second, the nature of the reproducible art possible to practice on the packet is very constrained in terms of design, complexity and even content because the substrate is functionally designed for its primary purpose of containing, preserving and dispersing the hand sanitizing fluid. Third, package printing is necessarily a high volume, mass production process where sameness is the rule both economically and operationally, this precludes any variation for essential custom marketing at a reasonable cost. Fourth, there is no overwrapping of the small flexible packet with packaging or even sufficient structure for attaching any form of promotion. Finally, packet printing is highly restrictive to the type of value adding promotions possible, it virtually precludes and question/answer format and curtails any following use because of the nature of being a disposable packet. Printing the packaging in the conventional manner of Harper is a useful step in achieving hand sanitizing fluid packet distribution but it is likely insufficient given the denoted limitations of the technique to achieve the deep and wide market penetration. Simply put, a new, novel and effective means of hand sanitizing fluid promotion needs to be created that can surmount the limitations imposed by small, disposable packets of liquid.
In the published literature and patent databases no solutions and minimal prior art could be found that gave guidance for overcoming the limiting design factors imposed by the Athand packet. Patents concerning fortune cookies disclosed techniques for embedding highly customized strips of paper bearing messages in various baked goods which do not lend themselves to packaging or surface printing (see U.S. Pat. No. 4,591,328 to Cheung and U.S. Pat. No. 4,797,291 to Pierce). Numerous patents disclosed variations on the surprisingly long-life technique of embedding promotions in the center of soap bars where the message stays viable even as the bar is consumed (see U.S. Pat. No. 165,628 to Strunz; U.S. Pat. No. 1,827,549 to Villain; U.S. Pat. No. 1,983,002 to Reeves; U.S. Pat. No. 3,413,230 to Dupis; U.S. Pat. No. 5,492,644 to Minkin; U.S. Pat. No. 5,869,437 to Wolfersberger; and U.S. Pat. No. 6,184,191 to Wolfersberger). Coupons inserted in various packaging formats to promote the associated products are described in many patents (see U.S. Pat. No. 4,837,956 to Dolence; U.S. Pat. No. 5,871,069 to Yakich; and U.S. Pat. No. 6,421,986 to Dharssi for examples). But none addressed the issues raised by the Athand packet concerning size, surface, uniqueness, structure, and format. Indeed, the problems broadened, every patent that discussed the issue of insert such as coupons warned of the soiling, spoilage and general contamination problems associated with placing any value adding component in direct contact with the packaged product (ibid. Dolence, Yakich, and Dharssi). This is especially true for liquid products in that nothing in the literature or patents was found describing a floating insert in a consumable liquid product. The prior art teaches away from any value adding insert being in direct contact with any product, and given the small size and nature of the packet, compounded by the aggressive qualities of hand sanitizing fluids such as the caustic effect of alcohol, the prospect of developing such a promotion appeared dim.
Research offered little, all references were found deficient in one or more respects. Significantly, none of the above references taken in part or as a whole presented an effective way to fabricate highly varied, small batches of promotional messages in a very small format, with high quality reproductive art, at the minimal expense imposed by the necessarily low product cost and disposable nature of the product. None overcame these and other problems, none suggested any advancement to current art in the manner of the present invention.